International Sanctions and the Procurement of Medical Equipment in Iran: A Qualitative Study

Abstract

Background: Despite regulations to facilitate the purchase of medical equipment, the process is now faced with severe challenges due to the sanctions. This study focuses on the effects of the international sanctions on the process of procuring capital medical equipment in the Iranian health system. Methods: A qualitative study using a content analysis approach was designed to investigate the effects of the international sanctions on capital medical equipment from January 2018 to June 2019. The data were gathered through 32 face-to-face, semi-structured interviews according to an interview guide. All the interviews were transcribed verbatim and analyzed accordingly. Thematic analysis with an inductive approach was employed for analyzing the data. Results: After a comprehensive analysis of open codes, two themes and 9 sub-themes were formulated. Based on our findings, the challenges facing the Iranian health sector during international sanctions included: “procurement of capital medical equipment” (with 6 sub-themes: Capital medical equipment suppliers, Monetary and interbank transactions, Suppliers and importers of the capital medical equipment, The process of procurement of capital medical equipment, Healthcare providers and Service receivers) and “repairing and after-sales services of capital medical equipment,” (with 3 sub-themes: Software and spare parts dependent repair, Specialized human resources dependent repairing and after-sales services). Conclusion: Even though the sanction has made Iranian scientists and technicians capable of re-engineering and producing some of the medical equipment and accessories, the study confirms the adverse effects of sanctions on the quality and quantity of medical equipment procurement, hence, delivering adequate and on-time medical services. In many cases, for money transfer issues, international companies were not sure they could have their money back if they sold the facilities to Iran. Fear of losing the US market was the other main consideration for the international companies.

Effects of the international economic sanctions on access to medicine of the Iranian people: A systematic review

“…Through the search strategy, we could identify 24 articles about various effects of the international economic sanctions on access to medicine and health of the Iranian people (Figure 1 and Table 1). 5,6,8–29 Sanctions have severely restricted patients with thalassemia 8,17 haemophilia, 8 cancer, 14 epilepsy, 5 and multiple sclerosis 26 from receiving their medical needs. Surveys and interviews of the patients 5,8,24,26 and healthcare professionals and policy‐makers 8,14,18,19,21,23–25,27,28 have repeatedly showed that sanctions have greatly affected the health system and access to medicines in Iran.…”

“… 5,6,8–29 Sanctions have severely restricted patients with thalassemia 8,17 haemophilia, 8 cancer, 14 epilepsy, 5 and multiple sclerosis 26 from receiving their medical needs. Surveys and interviews of the patients 5,8,24,26 and healthcare professionals and policy‐makers 8,14,18,19,21,23–25,27,28 have repeatedly showed that sanctions have greatly affected the health system and access to medicines in Iran. Market surveillances have shown that sanctions have reduced access to imported and domestically produced drugs 11,15 .…”

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey

“…[24][25][26] In addition, in recent years, Iran has had a growing inflation, which can also be a reason for that. [27][28][29] According to the findings of another systematic and metaanalysis study in Iran (2017), the prevalence of households faced with CHE was reported to be 3.9% (95% CI, 3.26−11.07). 30 Also, in the latest systematic and meta-analysis study in Iran (2018), in total, the percentage of households exposed to CHE was 7.5% (95% CI, 6.2−9.1) and for inpatient services was 35.9% (95% CI, 23.5−54.3).…”

“…Covid‐19 pandemic has affected the CHE index in various ways, such as increasing health costs, increasing unemployment, weakening the household's economic status, and reducing the household's ability to pay 24–26 . In addition, in recent years, Iran has had a growing inflation, which can also be a reason for that 27–29 …”

The human cost of economic sanctions and strategies for building health system resilience: A scoping review of studies in Iran

“…[16][17][18]42,43 Five other papers were reviews, [15][16][17][18][19] and the rest (=22) were original studies. Moreover, 12 papers used the quantitative design, 23,24,26,27,31,32,[34][35][36][37]39,42 whereas nine studies employed the qualitative design 17,[28][29][30]33,38,40,41,43 and only one paper adopted the mix-methods approach. 25…”